In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model.
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. Model for end-stage liver disease (MELD) relies on a few objective variables and predicts short-term survival. We aimed to determine the predictive value of MELD score, at admission, in the short-term mortality of SBP patients.


METHODS
We conducted a retrospective study of 73 SBP episodes admitted in our department between January 2002 and April 2006. Diagnosis (neutrophil count in ascitic fluid >or=250/mm3) was established within 24 h and cefotaxime was immediately started. Data collected included age, sex, etiology of liver disease, severity of ascites and hepatic encephalopathy, serum creatinine, total bilirubin and albumin, prothrombin time with international normalized ratio, and ascitic fluid analysis.


METHODS
Student's t-test, chi2 test, univariate analysis, logistic regression model, and receiver operating characteristic curves.


RESULTS
In-hospital mortality rate was 37%. In multivariate analysis, MELD score (P<0.001), and advanced age (P<0.05) were independent predictors of mortality. Receiver operating characteristic curve for MELD score revealed an excellent discriminatory ability to predict death, with an area under curve of 0.84. Age increased the predictive ability of MELD score, represented by an increment of area under curve to 0.88.


CONCLUSIONS
MELD score and older age were independent predictors of mortality. Age increased the discriminatory ability of MELD score to predict death. This new model may be useful for stratifying patients in future therapeutic trials, deserving further validation.
Nobre
Sónia Rito
SR
Unit of Gastroenterology, Hospital Center of Cascais, Cascais, Portugal. soninobre@hotmail.com
Cabral
José Eduardo Pina
JE
Gomes
João José Ferreira
JJ
Leitão
Maximino Correia
MC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications*; D003428:Cross Infection / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D017093:Liver Failure / Q000150:complications; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications*; D010538:Peritonitis / Q000150:complications*; D011379:Prognosis